# FANNO CREEK CLINIC LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609876705
- **Authorized official:** LARRY M REED (CLINIC MANAGER)
- **Authorized official phone:** (503) 452-0915

## Contact information

- **Practice address:** 2400 SW VERMONT ST, PORTLAND, OR 97219-1940
- **Practice address phone:** (503) 452-0915
- **Practice address fax:** (503) 768-9232
- **Mailing address:** 2400 SW VERMONT ST, PORTLAND, OR 97219-1940
- **Mailing address phone:** (503) 452-0915
- **Mailing address fax:** (503) 768-9232

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 2802 | OR | Yes |

## Other

- **Enumeration date:** 07/29/2005
- **Last updated:** 10/16/2007